Letter to a Medical Student — What % of Cases are From Detergent? — Part 3

I’m afraid I don’t keep track of citations electronically; I will add in citations after the last post.  There will be at least 4 parts.
AJ

[Part 1]  [Part 2]  [Part 4]
Part 3:

So when I say 25-60% of eczema cases result from detergents, I’m really considering the commonality of circumstances under which detergents would likely be the overwhelming factor in the outbreaks. These circumstances vary.

Because adults often have more complicated health pictures, and because they have naturally less permeable membranes, I would expect detergent as the overwhelming influence in a smaller percentage of cases than for infants or children. For infants, with their far more permeable skin and their still-training immune systems, the percentage is far higher.

Although, as I said, sometimes people can resolve the outbreaks by addressing one modulator or another, or all of them at once if relevant — the primary ones being detergents, environmental (or internal) mold/fungal/yeasts (or, for the internal, let us say, significantly imbalanced microbiome and consequences), or (typically certain protein) foods, or even in some cases the state of the immune system or membranes (skin, lung, and/or gut) health, because it’s all related — I think generally it’s possible to estimate how often the different major modulators dominate.

As you know, a number of studies have shown that pregnant women given beneficial bacteria (probiotics) during pregnancy reduced the rate of eczema in their infants by roughly 20%. [1]   It is my belief that these cases are the ones in which an imbalanced microbiome /fungal modulator would dominate had the eczema developed. Probiotics do more than just compete with fungal organisms, Lactibacillus has also been shown to repair the gut barrier. [2] (Also an important tangent I won’t go into, but this relates to the role of bio-surfactants and how environmental syndets interact.) Not that removing external detergents wouldn’t help those who would have developed eczema absent the probiotics— and there is overlap in the environmental strategies, relating to gut/membrane health as well — but for this segment of infants, about 20-30%, I feel the evidence suggests the fungal modulator dominates.

My observation from experience is that those for whom food is the overwhelmingly dominant factor is about 10% of cases. This is not a hard and fast number, it’s just based on experience, and could change based on conditions. As you know, even the rates of eczema around the world continue to change rapidly.

Other studies tangentially suggest roughly the same proportions: “…two-thirds of patients with atopic dermatitis have no measurable allergen-specific IgE. Are we not just measuring the right IgE? Perhaps, but not likely, considering patients with X-linked agammoglobulinemia (a disease in which patients have almost no IgE) commonly develop atopic dermatitis.” [3] (Note: IVIG, at least at the time of this paper, is normally processed with detergents and patients with X-linked agammaglobulinemia, I believe, need regular infusions. Again, not to go into a long discussion, but write back if you don’t see the applicability here.)

Noted Harvard pediatrician Dr. T. Berry Brazelton, whose writings in his book Touchpoints [4] gave me the spark that led to my own solution, observed in his book that he could prevent most cases of childhood eczema by identifying atopic parents and having them implement general allergy-healthy-home practices and avoid using detergents with their infants. I asked him just as you have asked me, on what research he based his recommendations, but he said it was just based on decades of medical practice and observation.

In his day, of course, there were fewer sources of syndets in home environments, and they tended to be less powerful. Given the instructions he gave, he would have been addressing the two most significant modulators. Given that this eliminated most cases of eczema — and considering the environmental differences between then and now — I feel his experience further corroborates my observation that the cases in which a food (usually a protein food from a short list) is the primary modulator and removing it completely resolves full-body eczema as well as fluctuations from various triggers, represents the smallest percentage of cases from these main modulators. (Let me repeat that none of these factors occurs in isolation, the food modulation relates to the state of the gut barrier, which can also relate to detergent ingestion and unhealthy balance of microflora.)

Although my perspective and problem-solving heuristic are novel, there are researchers who have been publishing along similar lines and whose work supports these contentions. The most notable is probably respected dermatologist Dr. Michael Cork in the UK, who has for many years had success when his patients remove all surfactants entirely. He does not make the distinction between soaps and detergents as I do — he writes about not using “soap” because of presumed consequences to the skin, but then goes on to underscore it by saying many “soaps” have detergents in them anyway. [5] I wasn’t aware of his work while we were problem-solving, but I think he has been publishing along the lines of surfactants playing a role in the eczema epidemic for years prior.

So our views are very similar. The main difference and a significant limitation of the no-surfactant approach is that it’s not really very acceptable to most people to refrain from getting clean — Dr. Cork’s assistant said this to me, the trouble is getting people to do it — and in my experience as well as my understanding of the problem, it’s not really necessary to refrain from washing. In fact, many of my site users (including doctors using the site) have commented on how healthy their skin remains even when they engage in frequent hand washing.

The main difference stems from perspectives on how skin is affected by washing. From empirical observation, I have come to see dryness and other impacts from washing as resulting from the residues of highly hydrophilic compounds ON the skin, because of the molecular properties of those residues and how ubiquitous those exposures are in modern environments, rather than the stripping of lipids from the skin by washing, which is the traditional view.

In fact, avoiding the use of traditional soaps with molecular properties that do not cause the kind of increased permeability that most modern syndets do, actually makes it more difficult to get results in typical modern environments. Where most people with uncomplicated histories can see results in as little as a few days to a week with my site strategies, and those with more complicated histories on the order of a few weeks to a few months, these no-surfactant-at-all approaches seem to take on the order of 6 months to 2 years, and the outcomes seem less satisfactory.

In relation to the abnormal influence of modern syndets, in my observation, everyone experiences a change in circumstances because of this environmental influence — degraded skin quality, often dryness that most people believe is inherent, otherwise increased susceptibility to allergic symptoms or amplified symptoms where an allergy already exists, exacerbated asthma — even though not everyone experiences eczema. Anyone under the age of 5 and over the age of 50 especially benefits from minimizing this influence just in skin quality. I believe virtually anyone has the capacity to express eczema under the right conditions, though. Certainly, worldwide eczema and atopy rates continue to rise, seemingly without bound. And in Sweden, which has some of the highest rates, researchers have noted the environmental factor seems related to something in the indoor environment. [6]

In any given situation, removing detergents, or changing another threshold factor (mainly environmental mold or certain protein foods, including via gut barrier health), or both, might bring a given person’s circumstances below the threshold of any potential for triggering the reaction.  If a person’s outbreaks could have resulted because of more than one factor, but that person removed only one of them and stopped reacting because of bringing a threshold up, that person would blame the eczema on that one thing, when they might as easily have achieved the same result, at least in the short-term, by removing the other factor.

I have had the experience with the site that some people will work very hard in their daily lives to remove triggers that cause outbreaks with each exposure — a pet, for example — only to find that when they follow the site strategies and go detergent-free, they can bring the pet back without the same breakouts or other allergic symptoms. (This is simpler with a dog; many cat litters have significant amounts of detergent in them or are otherwise highly hydrophilic compounds, but with the right awareness and choices, that influence too can be avoided.)

 

To be Continued in Part 4:

“To the question of estimating what percentage of the eczema/atopy problem relates to detergents … implies a broad understanding of the problem across the population …”

 

[1] Pelucchi, Claudio, Liliane Chatenoud, Federica Turati, Carlotta Galeone, Lorenzo Moja, Jean-François Bach, and Carlo La Vecchia. “Probiotics Supplementation During Pregnancy or Infancy for the Prevention of Atopic Dermatitis.” Epidemiology 23.3 (2012): 402-14.

[2] Rao, R. K., and G. Samak. “Protection and Restitution of Gut Barrier by Probiotics: Nutritional and Clinical Implications.” Current nutrition and food science 9.2 (2013): 99–107. Print.

[3] Anderson, P. Chris, and James G. Dinulos. “Atopic Dermatitis and Alternative Management Strategies.” Current Opinion in Pediatrics 21.1 (2009): 131-38. Web.

[4]  Brazelton, T. Berry, and Joshua D. Sparrow. Touchpoints: Birth to 3. Cambridge, MA: Da Capo, 2006. Print.

[5] still ISO this paper, I have the print somewhere… It’s an older paper than I am finding easily on Pubmed

[6] Aberg, N., B. Hesselmar, B. Aberg, and B. Eriksson. “Increase of Asthma, Allergic Rhinitis and Eczema in Swedish Schoolchildren between 1979 and 1991.” Clinical Experimental Allergy 25.9 (1995): 815-19. Print.

 

 

This work by A.J. Lumsdaine is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

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Letter to a Medical Student — What % of Cases are From Detergent — Part 2

This question was such a good one and needed a more complete answer than I could give in a short blog post.  I will be rolling out the entire letter in 3 or 4 parts, and refining it as I go.  I will be asking more than one doctor I know for feedback, and revising as needed.  Here’s the link to Part 1 of the letter.  I hope the information is helpful. 
AJ

 

Question from a medical student:

“On your website, you write that detergents may be responsible for eczema 25-60% of the time. I was wondering if you wouldn’t mind sharing with me how you found this number. It is very interesting that so many people have had relief from eczema after eliminating detergents and I was wondering if you could direct me to any literature corroborating this finding so I can look into it further.”

My Answer — Part 2:

This is a good question, and the answer not a simple one. The estimate is not really equivalent to a traditional epidemiological statistic, but rather it encompasses circumstances related to outbreaks, per my empirical observations and ideas, and a view of the relevant medical literature through this new lens.

On my website, I wrote that detergent-reactive eczema “likely accounts for 25-60% of eczema, depending on the age group and locality, higher if other allergies and an inherited predisposition are factors.” I believe I can now propose a revision of the Hygiene Hypothesis that not only accounts for the rise in eczema and atopy, but can satisfy conditions of causality and leads to solutions consistent with the underlying basis. However, the issue is more complex than saying one thing underlies a certain percentage of cases and another thing underlies others.

Eczema as a Signal — “Normal” and “Abnormal” Eczema

First, I should point out that I do not see eczema as a “disease” that some people have and others do not, in the way that a person might have dysentery or chicken pox. I believe eczema (and other allergic symptoms), under normal environmental conditions (such as we evolved with), is a helpful signal from the immune system to the conscious brain, in the way that pain is an unpleasant but helpful signal from the nervous system to the conscious brain.   (I have a stack of research papers that I believe directly supports this contention, but that’s a discussion for another day.)

At any given time, some people may experience no pain, some may experience more pain than others under similar circumstances, others more chronic pain than others for a variety of reasons. The percentage of people experiencing pain depends on the circumstances. Some circumstances happen more frequently than others. Sometimes accident or disease processes that trigger pain unnaturally cause the pain itself to essentially be a “disease” problem. But fundamentally, pain in our bodies is a signal that everyone can express.

I believe eczema and allergies, too, are signals. The signal of eczema is triggered under certain conditions. Actually, let me be very careful in how I use the word “trigger” here. I believe the signal of eczema can be expressed when a certain threshold is crossed. That threshold depends on a number of factors having to do with the environment and the immune system, membrane health being intimately tied up with these. Once that threshold is crossed, outbreaks may happen continuously, or every time a traditional “trigger” is encountered, such as dust mite exposure or certain pollens, for example. If one is below that threshold, then exposure to the traditional triggers won’t cause eczema, or won’t cause it unless there is a very significant exposure. (I discuss this conceptually on my site as the bucket analogy of allergy.)

This is worth restating:   I see allergy, “normal” allergy — I consider anaphylactic allergy as different — as an adaptation, not disease pathology. Given the historic prevalence of allergy even before allergy rates saw such precipitous rise after WWII, this makes sense. As with pain, virtually anyone can develop an individual allergic response at some point in life under the right circumstances. For any inherited condition to maintain such significant prevalence in the population, there must be some compensating benefit. Given the rapid rise in eczema and atopy since WWII, the cause of this “abnormal” allergy must be primarily environmental. Per Klueken et al (review, from Schultz-Larsen et al) [1], “This continuously increasing frequency of [atopic dermatitis] during the past 30 to 40 years suggests that widespread environmental factors in the industrialized world are operating in genetically susceptible persons.”

Let me also be very clear by restating once again that I am differentiating historically “normal” allergy from the modern manifestation of eczema and allergy, which are not normal. If eczema is a signal, most eczema today is almost certainly the result of unnatural environmental conditions inappropriately triggering that signal — or, modulating down thresholds to reacting — with a genetic component to the susceptibility. I believe based on my present understanding that the people with naturally lower thresholds to reacting in normal environments would otherwise have a genetic advantage.

Allergens are similar to pathogens to the immune system. To the extent that harmless allergens take more energy to differentiate from pathogens, there is probably a survival advantage to people (or — speaking to possibly evolutionary roots — to migratory groups that have such people among them) whose immune systems can tell them to reduce exposure to certain benign substances that make the immune system’s job more difficult.  An interesting aspect of allergy is that “normal” allergy makes sufferers miserable in a way that often points to the source of the misery — aeroallergens relate to breathing symptoms, contact allergens to skin, etc. — but without incapacitating.  Allergy concurrently increases adrenaline, giving sufferers the ability to move away from what is making them miserable.

I believe there is probably a survival advantage in the more ready expression of this signal under normal environmental conditions, and that there is likely a way to support my overall perspective on allergy using genetic archeology.

Restore more normal environmental conditions, and the signal is still triggered under the right conditions, only far less often and in a more “normal” and helpful way (giving the conscious brain important feedback). But the signal can be triggered in anyone, I believe, under the right conditions.

The ISAAC studies (I’m remembering off the top of my head, please correct me if it was another source — after I post this, I will go back and put in the citations in a few days anyway) (Feb 2017 update – I am not sure this is the original paper I meant but it’s close [2]), showed a roughly linear relationship between atopy rates and eczema rates by nation. If you accept that the expression of atopy is mainly the result of abnormal modern environmental conditions in recent decades — given the rapid rise, significant prevalence, and genetic aspect, most serious researchers take that perspective — then nations with the lowest rates of atopy would be most likely to demonstrate historically natural rates of eczema.  Off the top of my head, rates of eczema might be low single-digit percentages, or even a fraction of a percent.

I think there is a relatively short list of threshold modulators and a longer, well-known list of triggers. Threshold modulators are where I believe the solution to the eczema problem lies; they seem at first glance to be unrelated, but I think they can be tied together in a simple and logical way. (Also a long discussion for another day.) Detergents — which my site deals with at length because their role is as yet poorly recognized and they are a relatively new environmental issue — abnormally modulate that threshold. I believe high levels of environment mold exposure (to be more precise, dampness-related exposure), or abnormal internal fungal involvement, is one of the more significant normal modulators of the threshold, in fact, may be primarily responsible for the adaptation.

The World Health Organization report on Dampness and Mould/Guidelines for Indoor Air Quality http://www.euro.who.int/__data/assets/pdf_file/0017/43325/E92645.pdf notes that atopic individuals experience increased susceptibility to dampness-related health effects, and according to NIOSH, “a more recent epidemiologic review published in 2011 reported that indoor dampness or mold was consistently associated with bronchitis and eczema [Mendell et al. 2011][3].”

In other words, eczema is more readily expressed in the presence of increased indoor dampness/mold, and atopic individuals are more susceptible under the circumstances. In regard to internal fungal involvement, much research has been published over the years in regards to the use of antifungals with eczema. (Again, big topic for another time.) Some viral illnesses can, in the short-term, do the same. (I discuss this on the blog, I think.)

Certain protein foods associated with full-body eczema outbreaks, too, can modulate that threshold, or be both modulator and trigger, under different circumstances. As I said, I believe there is a connection between these and detergent effects, but that’s a complex discussion for another day.   (Discussed briefly in several posts on the blog.) Basically, I suspect compromised gut barrier leading to proteins in the blood stream — and consequently increased levels of circulating endogenous detergents to denature them — has a similar impact to abnormal environmental detergent exposures. Associated outbreaks could run the gamut between normal and abnormal and/or amplified by other abnormal threshold modulators.

Abnormal environmental conditions today lead to abnormally lowered thresholds to reacting, especially in those with a certain genetic susceptibility. Abnormal environmental conditions also effectively amplify traditional triggers (for example, detergents are known to increase antigen penetration).   Again, this isn’t necessarily a topic I can cover in this letter, but I believe all of these seemingly unrelated factors tie together.

There is a proportionality to the reaction to detergents — a proportionality to the impact on permeability — but the reaction itself is not a simple irritant or an IgE-mediated allergy to detergents, as I discuss on my site. The eczema, I believe, in its abnormal manifestation resulting from abnormal environmental influences today, is an amplified, unnatural triggering of a normal signal.

So when I say 25-60% of cases result from detergents, I’m really considering the commonality of circumstances under which detergents would likely be the overwhelming factor in the outbreaks. These circumstances vary.

 

To be Continued in Part 3:

“… — I think generally it’s possible to estimate how often the different major modulators dominate.”

 

[1] Klüken, H., Wienker, T. and Bieber, T. (2003), Atopic eczema/dermatitis syndrome – a genetically complex disease. New advances in discovering the genetic contribution. Allergy, 58: 5–12. doi:10.1034/j.1398-9995.2003.02162.x

[2] Flohr, C, et al. The role of atopic sensitization in flexural eczema: findings from the International Study of Asthma and Allergies in Childhood Phase Two. The Journal of Allergy and Clinical Immunology. 2008; 121(1):  141147.e4. doi:  10.1016/j.jaci.2007.08.066

[3] Mendell, Mark J. et al. “Respiratory and Allergic Health Effects of Dampness, Mold, and Dampness-Related Agents: A Review of the Epidemiologic Evidence.” Environmental Health Perspectives 119.6 (2011): 748–756. PMC. Web. 17 Feb. 2017.

 

 

This work by A.J. Lumsdaine is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

 

 

 

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Letter to a Medical Student — What % of Cases Are From Detergent? — Part 1

I appreciate hearing from someone in medical school.  When I first wrote the website, I was doing citizen science before there was a term for it, so I had no framework to do anything but share through our own journey, in order to help as many people as possible until I could write something more traditionally scientific.  I thought the site would appeal mostly to natural practitioners but be ignored by allopathic practitioners until I could do a study and publish in more traditional outlets.

I found almost the opposite.  Don’t get me wrong, I’ve heard my share of positive feedback from naturally-oriented practitioners who found the site useful.  But I’ve actually gotten the most ready acceptance from allopathic practitioners who read the site.  If they just glance at it or page through it and think they know what it says, they may be dismissive, but if they actually read it, they are invariably positive, even enthusiastic.  I’ve heard from many doctors over the years who not only have used the site for their families, but refer patients to it.  I’ve been thanked by many parents who had my site information because a doctor gave it to them.  I’ve heard from doctors who just appreciate being able to wash their hands frequently and still have healthy skin.  My own doctor once told me that she had just commented to a colleague that, “She really has solved eczema!”

I think the reason my site has been surprisingly well-received by allopathic practitioners is that my perspective pulls together so many loose threads from available research, and views the whole through a new lens that is consistent with what is already known.  I’m putting empirical problem-solving into the context of the available research, with which it is absolutely consistent.  Too often people make good empirical observations and then overlay a vague and unscientific framework to explain it (which may or may not be accurate or generalizable, often not).  It’s not surprising then that allopathic physicians don’t accept the empirical observations, no matter how sound.

And, there is a difference between understanding something scientifically and getting people to implement a problem-solving heuristic in order to address an environmental problem affecting their health — my site is mainly a problem-solving heuristic, although I do have to explain enough that people understand why because my perspective is so different.  People still need their doctors in implementing such a heuristic for safety’s sake, for anything medical really, but the site is not a medical treatment per se, so doctors who understand what it’s trying to achieve typically appreciate having that resource available.

The one specialty exception has been dermatologists!  Which is understandable, because what I am saying does in some ways fundamentally conflict with what they learn about the skin.  For example, one of the key stumbling blocks is the accepted traditional idea that skin becomes dry from washing because of lipids stripped from the skin.  I take a different view, that skin becomes dry because of water loss resulting mainly from the molecular properties of residues ON the skin, residues left from washing or absorbed from contact with dust or surfaces.  (See previous blog posts for more — scroll down to links for “Posts on understanding and solving dry skin”.)

My view is really radically different, but if you think about it, the idea that skin is dry because of stripped oils or lipids from washing is more an educated assumption not incontrovertibly proven by thorough scientific study, the way it was assumed in the early days of AIDS that the virus was dormant rather than locked in a fierce battle with the immune system which the immune system eventually loses, as was eventually found.  My view that the water loss results mainly from the interaction of (primarily syndet) residues of certain molecular properties with the skin isn’t yet proven, either, but it’s at least consistent with very basic biological science that every medical student learns.  Most importantly, my view pans out in solving the problems of dry skin from washing and very often, eczema.

So…

You asked how I came up with the statement that detergent-reactive eczema “likely accounts for 25-60% of eczema, depending on the age group and locality, higher if other allergies and an inherited predisposition are factors.”

(I’ll answer that in my next post.)

Best regards,

AJ Lumsdaine

Dogs and Cats Get Eczema Too: Feline and Canine Atopic Dermatitis also on the Rise — How to Make a Healthier Home for Pets

Using SolveEczema.org for dogs and cats with atopic dermatitis:

Scratching Dog

Image courtesy of anankkml / FreeDigitalPhotos.net

Atopic dermatitis is not just a growing problem for people, more and more household pets are suffering as well. Horses can be affected, too. I will deal with this topic a little more in my book, but I felt like I had to write at least something now.  Because dealing with this issue for dogs, cats, and horses is far easier than it is for babies, animals cannot help themselves by telling us how they feel, and these environmental aspects of the problem are addressable and not their fault.

Households that try these environmental strategies may also find that in addition to helping skin, the animals may themselves end up less allergic, and be less allergenic to people.

As I point out on the SolveEczema.org website, these are my own ideas, they are novel;  I am not a health professional and I am certainly not a vet.  The ideas are the result of “citizen science”, consistent with the body of available mainstream research but have not themselves yet been the subject of such research.  The information is supposed to augment the relationship between health professional and patient, not supplant it.  I always strongly suggest people keep their health professionals in the loop, and that’s not just a liability disclaimer, it’s because it’s important.  Your doctor or vet or naturopath knows you, your child, your pet, and if anything else is at issue or something goes wrong, they know what to do to keep you safe.  Having a trusting, working relationship with a good health care provider is like gold.

As I also point out on my website, it’s necessary to read through the information before making any changes, and especially before making assumptions.  People often incorrectly think they know what the site is about, and either take the wrong or inadequate measures, or dismiss it out of hand.

For example, many people believe that because there is a genetic component to the susceptibility, that the problem cannot be primarily environmental in origin.  There are actually fundamental reasons under the circumstances that the problem CAN’T be primarily genetic even when there is a strong genetic component, which I will discuss in the book.  People — and pets — with the atopy, those WITH the genetic susceptibility, are the most likely to be HELPED by these environmental measures.

The fundamental problem for cats and dogs is this:

*The dust in people’s homes, which cats and dogs are more directly affected by even than people, is full of substances that significantly impact the permeability of their skin.  The increased permeability leads to excessive water loss, dry skin, and more allergens crossing the skin barrier.  The disrupted skin is also more susceptible to bacterial and fungal infections, and not just because of the broken skin, but because the substances inactivate important proteins.  These substances also increase healing time of membranes.  Solving this problem involves changing what is in the dust, which is very doable, not having a dust-free home which is impossible.

*The surfaces dogs and cats spend most of theirs days lying on are coated with these same substances, which can be absorbed from contact.

*Many of these substances are in the fertilizer and poison products sprayed around peoples grass and homes outside as well, which dogs and cats also spend a lot of time in contact with.

*Most commercial cat litters are full of these substances.  When a cat grooms herself, she not only ingests them, she also dissolves these substances into the dander, making the dander even more allergenic than otherwise.  When a cat walks around the house, these substances are tracked around the house and added to the dust of the home.

*Most products used to wash dogs, even “natural” ones, contain these substances, and residues left in their coats (and there are ALWAYS residues) cause the same problems described above.

boy and dog

Image courtesy of Ashley Cox / FreeDigitalPhotos.net

Trying the strategies from the website does not have to be a lot of work.  Please be aware that the site is geared to people with infants who have the most permeable skin and greatest susceptibilities, and who need to see the fastest, most dramatic results.  To help animals, you don’t have to sweat the small stuff, just be aware of what measures will have the greatest benefit and impact.

A few things to remember:

*Please only make changes AFTER reading and understanding the website.  Begin with the slideshow overview to understand.  It is 45 minutes long, only 6 slides.  My apologies to everyone, I originally made it for a crowdfunding for the book, I am not a media person, and the video puts even ME to sleep (sorry!).  It is still the most up-to-date summary and worth beginning with:  http://vimeo.com/33522513

*Helping a cat or dog with AD is not as difficult as helping an infant human — the whole house has to get on board, but you won’t have to sweat the small stuff (like makeup or deodorant) — however, the same principles apply.

*Keep your vet in the loop. Treat as recommended by your vet, especially for bacterial or fungal problems that may have developed, as well as flea control.  Where treatment product choices are possible, choose only products that don’t contain detergents as defined on the SolveEczema.org website.  DON’T MAKE ASSUMPTIONS ABOUT WHAT THAT MEANS! (People are almost always wrong when they assume.)

*Treating fungal problems is more of an art, and can sometimes require long-term application.  Treatment fungal problems initially can cause Jarisch-Herxheimer responses, known as “die-off” reactions, which seem to make things worse.  This disruption in the membrane can actually make things worse and stymie results, plus it’s just uncomfortable for the pet patient, so effective antifungal treatment may involve both using a steroid temporarily with the antifungal, followed by longer-term antifungal therapy.  To minimize die-off for a known fungal problem, sometimes it’s necessary to back off the treatment and begin very, very slowly, with very small amounts ramped up to full strength, and to treat for a very long time.  Switch treatments if one no longer seems to work.

*Getting a good well-filtered vacuum is an essential step.

vacuuming

Image courtesy of artur84 / FreeDigitalPhotos.net

*If you have carpeting, especially old carpeting, consider removing it and replacing it with some kind of non-allergic surface like hardwood flooring or Marmoleum/natural lineoleum, perhaps with area rugs as necessary (washed only with non-detergent products).  A friend clued me in to a way to find Marmoleum cheaper:  Talk to the local supplier and ask if you can add square footage to the next really large order they get (provided you like the material).  We know someone who got really high quality Marmoleum for the price of cheap vinyl that way.  Natural linoleum is not as easy to install and it’s better to have an experienced pro do this.

*Can you wash out the cover of your pet’s bed or bedding?  Follow the SolveEczema.org website strategies for superwashing.  If you have hard water, it may take more washing than suggested.  Use one or two washes with just 2 cups of white vinegar in the wash.

*Remember that the dust in your home is mostly made up of your skin cells, hair, and lint, and that your pet spends most of their day in it.  Marketing is powerful —  even if there are better ones out there, people can be very strongly and irrationally attached to their personal care products (especially since there can be worse ones out there).  You’re just changing what you use in order to help your pet, and it does not have to be a compromise, you can find things you like as much or better, but you may find some you like less in the process.  Don’t give up!

*For most good products, the biggest influence on whether new products work well and produce lovely results, in my experience, is not the products themselves but the hardness of the water.  It will be more difficult to find acceptable products for people with hard water.

*If you don’t have time to superwash the laundry, you can take a lower-key approach that may take longer and produce results more slowly over time, but is far less work.  First, switch to a very benign detergent like Planet (the only syndet I feel comfortable recommending) for a few weeks.  Then switch to just using baking soda and/or vinegar in the laundry for a few more weeks.  Then switch to true soap in the laundry, but wash each load twice.  Once with soap, and then once with just water.  Be sure to follow all the directions about washing out the dryer of previous detergent residues, and be sure to clean out all the detergenty lint in the laundry room.

*For cats, investigate non-clumping cat litters, like cedar chips.  Unfortunately, the clumping litters are the ones with significant amounts of detergents or clays that are very hydrophilic and could theoretically cause the same problems.

*Take a look at the ingredients of the products you use in your yard and patio — detergents are very commonly used in all kinds of products like fertilizers and poisons because they reduce surface tension and spread products more evenly.  example link

dog in bowl

Image courtesy of imagerymajestic / FreeDigitalPhotos.net

*In the case of benefiting just the animals, you also don’t have to switch your dishwashing products, but I recommend doing so anyway as a healthy step for the benefit of everyone’s mucous membranes.  Our digestive systems make up a goodly portion of our bodies’ immune systems.  If you don’t take this step, do at least buy non-detergent soaps to wash the water bowls and toys of pets with AD.

*You can’t necessarily use bathing to control exposures of animals as you can children, but you probably won’t need to.  But still, use baths judiciously relative to exposures, as “eczema removal time”, such as when the dog (or cat, IF appropriate) is scratching from spending time in the yard.

*With pet fur, it’s also probably impractical to moisturize.  People who use the site strategies usually find over time that they no longer need to anyway.  Absent these abnormal environmental influences, a pet’s skin should not need moisturizing.  As with humans, the creamy absorbing moisturizers can backfire and cause more water loss later (see SolveEczema.org blog posts about dry skin).

*Most vet sites recommend to control other environmental allergens like mold and dust mites.  I will write more about this contributor to dermatitis for people, too, soon.

*Remember that even people who do not get eczema themselves usually benefit from these steps in the health of their skin and other membranes.  it may not be apparent at the beginning, but a few months into this, pay attention to your own skin — you may find it’s better than you ever remember.  If not, you should find better products, because they exist!

*Although all members of a household usually benefits from the SolveEczema.org strategies, it’s normal for pets to have eczema but not the humans, or vice versa, or for both to have it.  (The reason for that should be evident from reading the site and blog.)

*I know how difficult it can be to change products.  Marketing is very powerful, even when people are aware of it.  I remember what that’s like, but now feel much happier with most of the best products I’ve found.  That said, dogs and cats are likely to see some results even if there is a “holdout” in the household.  If you try the site strategies for your pets with eczema, please let me know how it goes.

I have listed some pet products on my Amazon astore, which is there for people’s convenience, but there are other products out there, and the site discusses how to evaluate them.  When people purchase through those links, I receive a small percentage without increasing the buyer’s price (usually on the order of $15/month, not significant, but I need to say so in case it makes a difference to people one way or another).  The link is:  http://astore.amazon.com/solvsblogastore-20

Use a search engine to learn about “canine atopic dermatitis” — although I don’t necessarily agree with various sites about what to do about it, it’s clear that it’s a growing problem.

If you are helped by these strategies, please consider returning to the website donations page and making a donation — most people don’t (and that’s okay, that’s obviously not why I do this!), but they do help.  People are often willing to pay far more for treatments that don’t work, so if this has been worthwhile to you, please consider a donation, it does help.  Thanks!
A.J. Lumsdaine

http://solveeczema.org/donate.html

 

 

Favorite posts and annual autumn-eczema reminder

Autumn by Monika Lumsdaine

Autumn – by Monika Lumsdaine
A favorite photo

Every year when the weather turns, thresholds to reacting drop along with declining temperatures and humidity.

The change can be hardest of all on people who have recently solved their child’s eczema or are in the process, because it can suddenly seem as if something else is causing eczema to resurge.

Especially for those whose children are age 3 or younger, it’s worth a re-read of my first post on Autumn Eczema.

Also, because kids with eczema often have more allergy issues, I’ve posted our family’s best cold and cough home remedy (which I’ve moved to its own page).

 

And while I’m at it, here is a compendium of my very favorite posts [updated December 2015]:

Some summaries – what SolveEczema.org is all about:

My favorite FYI’s:

Posts about finding soaps and non-detergent products

What some other people have done (or not):

My very favorite Off-Topic Posts:

 

Creative Commons License
Autumn by Monika Lumsdaine is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

Some Badger Sunscreens Recalled for Contamination

badger sunscreen lotion

Some Badger Kid and Baby sunscreens recalled

Since I recommend this sunscreen as one of the best for SolveEczema.org users, I just wanted to post this voluntary recall information:

“Some Badger sunscreens are being recalled after potentially-dangerous bacteria and fungus were found during testing….”

http://www.cbsnews.com/8301-204_162-57604845/badger-kids-sunscreens-recalled-for-bacteria-fungus/

 And for Canadian users (thanks to Julie for the link!):
Here’s the link directly to the Badger site with the UPC and lot #s:
Please check your sunscreen right away!  I have used this sunscreen for years — love it! — and think they are doing the responsible thing by letting consumers know.
For notices like this in the future, sign up for email notifications of posts, or follow me on Twitter @ solveeczema
(Okay, I still have no idea how Twitter really works, or if saying @solveeczema or #solveeczema even gives the right information to people who want to do so!  I will post the recall link from the Badger site there, but since I just started there and have no followers on Twitter yet, I’m not exactly sure for what purpose…  Kind of pathetic, huh?  Refer to my “I am not a Luddite” missive below…  )

 

 

 

 

I Am Really Not a Luddite, Just Finite

I am really not a Luddite.

I tried using Facebook, but somehow it wouldn’t let me separate SolveEczema.org from my personal page, so forget that.  After making some monumental blunders — such as replying “yes” when it asked if I wanted to import my contacts from Yahoo, only to discover it had automatically spammed everyone who had ever written to me about the website with a Facebook request — I closed and deleted the account.

I know it’s possible to separate the personal and professional on Facebook — or maybe not, I’ve heard differing opinions —  I just haven’t had time to figure it out for myself.  As someone who truly grew up hand-in-hand with the age of technology, I no longer suffer arcana well.

My undergraduate advisor at MIT was a brilliant semiconductor device physicist, David Adler, who was very proud of the fact that he’d never used a computer.  “That’s what graduate students are for,” he would say.  His work enabled the building blocks of computers, but he had no time for them himself.  I have always envied him those graduate students!

Ape the book coverI am finally making progress on my book, so I purchased a copy of APE: How to Publish a Book by Guy Kawasaki and attended a lecture by him at my local bookstore.  It’s brand spanking new advice about a rapidly changing field, and every bit as readable as his other books.  Since I have always intended to self-publish, Kawasaki’s APE was exactly the right book at the right time.

While I think he’s absolutely spot on with his advice — his advice is sound,  his advice is great!  — much depends on building a social media platform.  But how am I going to do this without a graduate student or two?

His suggestion to me at his lecture was to hire someone to help.  Yes!! That would absolutely solve the problem, it just can’t happen on my side of reality for now.  We live in different worlds, Guy.

My website stats tell me this year SolveEczema.org has already had over 40,000 unique users — as many as all of last year — and the vast majority arrived from bookmarks and links, not search engines, with multiple page views per user, meaning, people are sharing.  The blog gets between roughly 1,200 and 1,700 views per month (how many unique users that means, I don’t know.)

So how do I turn that into followers on twitter or Google+ (whatever that is!)?  (I am not a Luddite!  I am not a Luddite!)

That was a poor and backhanded way of apologizing for taking so long to finish this book.  I spent much of last year as the crazy parent trying to improve indoor air quality at our local school, where my son began experiencing some pretty significant allergy problems, and so did I and my husband, truth be told.  The school ended up doing a great deal, and the experience was not wasted and will become another chapter in the book, as allergy and eczema are so related.  I learned much in the process, as always.

This is also a backhanded way of explaining why Guy Kawasaki’s book is my first twitter post!  You can now follow SolveEczema.org on twitter!  (I think…)

 

Master List of Laundry Soaps

Sources of pure soap laundry powder or liquid

Always check ingredients first, manufacturers change product ingredients all the time.   I have compiled some of these along with other non-detergent products on an Amazon astore for convenience, and some of the links below go directly (most of the mfr links went bad).
http://astore.amazon.com/solvsblogastore-20
A small % of astore purchases goes to SolveEczema if purchased through the link, on the order of $15/month).  Unfortunately, not all of these laundry products are available on Amazon so I can’t easily include most of them in the astore.

To save money or time, do it yourself!  There are many online recipes for laundry powder and gel using bar soaps, and various amounts of borax, washing soda, and baking soda.

Here are the pre-packaged products I found:


pure soap flakes

Pure Soap Flake Company
Laundry powder, soap flakes, soap bars

 

 

 

 

 

 

Pure Soap Flake Company
http://puresoapflakes.com/
They have an unscented laundry powder which is just simple soap, baking soda, borax and washing soda.


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cal ben seafoam laundry soap

Cal Ben Seafoam Laundry
25 lb. box

Cal Ben Seafoam Laundry Soap
http://www.calbenpuresoap.com/seafoam-laundry-soap.php

More complicated list of ingredients than most of these, plus sprayed with citrus oil, but it’s essentially soap-based.  I have used this product successfully.

 

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Zumclean-sweetorange-laundrysoap

Zum Clean Laundry Soap

 

 

 

 

 

 

 

 

 

 

 

Zum Clean Laundry Soap
64-oz Sweet Orange on Amazon
http://www.indigowild.com/category/natural-home-cleaning/
Liquid laundry soap, various fragrances.  No unscented.

 

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vermont soap

Vermont Soap Liquid Sunshine
Other Vermont Soap products work for laundry

Vermont Soap Liquid Sunshine Nontoxic Cleaner Concentrate

Gallon Vermont Soap Liquid Sunshine on Amazon
http://shop.vermontsoap.com/Liquid-Sunshine-Nontoxic-Cleaner-Concentrate_p_59.html#.UZBrGo7DIVQ
Vermont Soap has other liquid products that can be used in the laundry.  Their website describes uses for each product.

*

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Dri-Pak Soap Flakes
through MSO Distributing


dri-pak soap flakes in a bag
Dri-pak soap flakes on Amazon
http://www.msodistributing.com/shop/orders.html

Pure soap flakes may work better if combined with baking soda, washing soda, and borax, per many recipes on the web

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 *

Dr. Bronners baby mild soap

Dr. Bronners Liquid Soap

Dr. Bronner’s
32-oz Dr. Bronner’s Baby Mild liquid on Amazon
For many people, the only easy soap to access is Dr. Bronners.  Unscented Baby Mild as probably the best place to start.  Combine with baking soda, borax, and washing soda for better efficacy in laundry.

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Savon de Marseille flakes

Savon de Marseille
Traditional French Soap

Savon de Marseille Soap Flakes
Marius Fabre Marseille soap flakes on Amazon
Traditional soap flakes.  Can be combined with washing soda and borax, especially in hard water.  (It may pay to shop around, these are expensive.  Their liquid soaps use minimal ingredients and pure olive oil, and are also an option combined with washing soda and borax.)


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pure soap works laundry soap

Pure Soapworks Liquid Laundry Soap or Laundry Powder (Canada)
http://www.puresoapworks.com/specialtysoaps.htm 
This company seems to carry a full line of soap products.

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Zote Laundry Soap Flakes

Pack of 8 (17.63oz) Zote laundry soap flakes on Amazon
Still the most popular laundry product in Mexico.  (From animal tallow.  Also contains fragrance and optical brighteners.  Despite it being soap, users must take care if allergy to fragrance or optical brighteners might be an issue.)

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Grandma’s Laundry Soap

Grandma's Laundry Soap

Grandma’s Old-Fashioned Laundry Soap


Grandma’s laundry soap on Amazon
http://grandmaspureandnatural.com/laundry

A lard-based soap flake product.  This appears not to have any dyes or unnecessary ingredients.  This company also sells a soap-based stain remover stick and bar soaps.  They seem to understand the difference between soap and detergent per the site.

 

 

Off Topic (sort of): Is the Placebo Effect Real?

In order to help people with my site and blog, I try to stay away from saying anything controversial — aside from my belief that eczema is eminently solvable and understandable, and that there is nothing really wrong with these kids absent these relatively new environmental influences.  I only wish what I have to say in this post weren’t controversial — I don’t know why it is, but it is.  Forgive the lack of photos, I’ll try to remedy that soon.  This post is excerpted from a letter I wrote many years ago, and it highlights the philosophy that led to the way I went about problem solving eczema for my son.  I have posted this opinion anonymously online since, but I may as well come out and say it.  There are critical (unnecessary) barriers to solving intractible health problems, and real people suffer while we all wait for those in ivory towers to break them down.  In the era of distributed knowledge and the Internet, that must change.

When people use the site to problem solve their own children’s eczema, the breakthrough is usually when they can see the eczema outbreaks are not random.  In my experience, when people accept they can solve the problem, they are more than halfway there.  When they see they are in control, they’re there — they may not yet have all the influences or rashes eliminated, but they know they can do it.  I believe the perspective discussed below could help solve other currently-deemed intractable diseases.  I hope the following is helpful to others:

—AJ Lumsdaine, SolveEczema.org

More than ten years ago, Danish researchers Hrobjartsson and Gøtzsche published the watershed study, “Is the placebo powerless?  An analysis of clinical trials comparing placebo with no treatment,” in the New England Journal of Medicine.  The two researchers looked through the history of placebo-controlled clinical trials and found over 100 studies that included three patient groups rather than two:  1) a group given treatment, 2) a group given a placebo intended to mimic treatment, and 3) a group given nothing at all.  The authors decided to compare the groups given nothing to the placebo groups, and found that there is no significant clinical effect associated with placebos.  In other words, the placebo effect – interpreted as improvement resulting from patients’ belief in a treatment – is more myth than reality.

As you might imagine, the study generated quite a firestorm in the medical community.  I remember reading a letter by the head of Harvard Med School, in which he scratched his head at the earth shattering results, but also said he wouldn’t want anyone to give him a placebo.

And after such earth-shattering results, then what happened?

Hrobjartsson and Gøtzsche followed up with another study in 2004:  “Is the placebo powerless?  Update of a systematic review with 52 new randomized trials comparing placebo with no treatment.”  Again they “found no evidence of a generally large effect of placebo interventions.  A possible small effect on patient-reported continuous outcomes, especially pain, could not be clearly distinguished from bias.”

Although these researchers were arguably the first to make a dent in ironclad beliefs about placebos, especially in the media, they are not the first to analyze and refute the concept.

In 1997, researchers Kienle and Kiene wrote, “In 1955, Henry K. Beecher published the classic work entitled “The Powerful Placebo.”  Since that time, 40 years ago, the placebo effect has been considered a scientific fact.  Beecher … claimed that in 15 trials with different diseases, 35% of 1082 patients were satisfactorily relieved by a placebo alone.  This publication is still the most frequently cited placebo reference.  Recently Beecher’s article was reanalyzed with surprising results:  In contrast to his claim, no evidence was found of any placebo effect in any of the studies cited by him.  There were many other factors that could account for the reported improvements in patients in these trials, but most likely there was no placebo effect whatsoever.  False impressions of placebo effects can be produced in various ways. … These factors are still prevalent in modern placebo literature.  The placebo topic seems to invite sloppy methodological thinking.  Therefore awareness of Beecher’s mistakes and misinterpretation is essential for an appropriate interpretation of current placebo literature.”

No one is claiming that placebo-controlled trials are unnecessary.  On the contrary, these studies further emphasize the importance of placebos in clinical trials to eliminate the junk drawer of biases and other effects that needs to be separated from the clinical effect of the drug or treatment under scrutiny.  But the studies also point out how sloppy definitions of the placebo effect have perpetuated false beliefs.

The popular lay understanding of the placebo effect — the myth — is of powerful physical changes that result from an expectation or hope, a belief that good will happen if one is taking a medication (or that bad will happen if one is expecting bad side effects).

On the other side of the spectrum, is the definition of placebo effects as what is attributable to everything else that is not a medication effect – including the natural course of the illness, other effects caused by a placebo, even reporting biases among researchers and patients.  When the definitions are confused, the placebo effect is falsely supported as resulting from belief in treatment.

For a classic example of confusing changes from belief in treatment with other effects caused by a placebo, look no further than a watershed arthroscopic surgery trial from a few years ago, meant to test whether placebo-controlled surgeries are necessary and oft-cited as demonstrating that placebos are powerful.  Unfortunately, the many who wrote about this study as proving the power of placebos, meant placebos-as-causing-physical-effects-from-expectation.  But that’s not how the researchers of the study were using the term.  (This is one reason, especially in this day and age, full medical articles really must be made available to everyone online, not just abstracts.)

Patients were divided into three groups — patients to receive one of two popular arthroscopic surgeries, and a patient group to receive a sham surgery in which they were operated on and closed up without any actual surgical intervention.

Patients in all three groups improved, and this was taken as proof the placebo effect is powerful, and equated to mean the belief in treatment produces powerful effects.

But in fact, if people read the full article, they could see the placebo in this study wasn’t just the surgery.  Patients in all three groups – those given one of two different kinds of common knee surgeries and those in the placebo surgery group – all patients followed a comprehensive regimen of rest, walking aids, gradual exercise, and analgesics, in addition to their surgeries.  So, the placebo in this study was not just a sham surgery, the placebo was a sham surgery AND a comprehensive regimen of rest, walking aids, gradual exercise, and analgesics.  Unfortunately, there was neither a group that got the same regimen of rest and rehabilitation but did not get surgery at all, nor was there a control group that got nothing, to determine whether the observed improvements were from an independent effect of the placebo (i.e., improvements from just the rest and rehabilitation) or the natural course of the disease.

The study authors merely examined whether two common knee surgeries produced better outcomes than a placebo surgery (they did not), the study design in no way supported the existence of real clinical changes stemming from patients’ belief in treatment.  In fact, the study authors made oblique reference to the Hrobjartsson results and suggested themselves that the effects they observed could be the result of the natural course of the disease or related to an independent influence (but not the result of a belief in the treatment).

Despite such serious research supporting the need for a revolution in how we think about the placebo effect, nothing has really changed in over a decade.

Too few studies bother to delve into how the natural course of a disease plays into the picture.   If we know now from definitive research that improvements aren’t from belief in the treatment, but the result of something else, shouldn’t we be acting on this?

I’m sorry to burst one of the happiest bubbles in popular medical mythology, but there is just no good evidence that belief in a treatment alone produces a significant clinical change down the road, only wishful interpretations that it does.

Now, I’m not suggesting there is no mind-body connection, far from it.  I’m only saying that just because we see some obvious mind-body connections, does not mean that the conscious brain has unfettered control of all physiological processes.  Just because you can jump over a box, does not mean you can leap tall buildings in a single bound.

I’m also not saying, believe it or not, that there will never be a role for harnessing hope in medical treatment.  I’m just skeptical that sham treatments are the right vehicle.  If a passenger tries to catch a moving train, for example, a sudden surge of hope might make all the difference in whether she catches it and reaches her destination.  The surge in hope won’t allow her to keep outrunning a train forever, though.  In other words, a short-term belief could affect the long-term outcome in a significant way – but only if the train is real, not a mirage (or a sugar pill).

There is a much more serious issue at stake here than whether we can harness the power (however minor it has proven to be) of belief in treatment.  The popular concept of the placebo effect—as resulting from belief—undermined the crucial role of empiricism in medical practice, which has in turn seriously degraded the scientific authority of clinicians (even within the medical profession, very rigorous and scientific observations by good clinicians of individual patients are typically deemed “anecdotal” by definition).  This has in turn led to an over-reliance on statistical studies in medicine to problem solve for individuals (leading naturally to “one-size-fits-all treatments”), rather than to PROVE solutions found through empirical means.

In the decades since the concept of the placebo effect was first embraced, how many millions of times have doctors come across clinically significant improvements in their patients, even cures, but dismissed what they saw as the probable result of their patients’ beliefs in treatment, the irreproducible products of their patients’ minds?  How many times have clues to cures been left uninvestigated because of how beliefs about placebos lead to handwaving about the “vagaries of the human body”? 

We know now, we have solid proof now, that significant clinical changes are not the result of beliefs but of something else.  Something else — like the rigorous plan of rest and rehabilitation in the arthroscopic surgery study — that could, through empirical problem solving, be discerned and tested and turned into a solution or many solutions.

Every day, the belief that clinically significant improvements in individuals may merely be the result of the placebo effect costs our world opportunities to solve or cure tough diseases.

Eczema, detergents, and bat white-nose syndrome?

When I originally wrote SolveEczema.org, I always understood that a medical study or publication would be necessary to bring the ideas into the medical mainstream.  I did the site because I wanted to help as many people as possible in the meantime.  

I have also always realized there are other implications to these ideas beyond eczema, but didn’t feel in a position to write about them.  I was moved recently by reading a Science News story about bat white nose syndrome, which is so lethal, the word “extinction” is being bandied about.  I spent weeks composing an email to a respected bat researcher who is on the forefront of trying to save these beneficial creatures.  I’m sure this is going to seem like it’s coming from left field, so it’s unlikely to make an impact.  But as with writing the SolveEczema.org site in the first place, I had to try.  

I’m posting the letter here, edited for clarity, as it again discusses some of some of the ideas underlying SolveEczema.org.

A.J. Lumsdaine

Little brown bat
Credit: Missouri Dept of Conservation

Dear Dr. Reeder,

I have followed your work on bat white-nose syndrome in lay publications like Science News. I have for many years been concerned that something like this could happen to bats because of an unrecognized environmental influence that, if at issue, I’m surprised took even this long to cause such devastation.

I have to ask you to please bear with me while I explain.  There are so many preconceived notions to overcome about what I am about to say, there isn’t really an easy way to say it.

For 8 years now, I have run a noncommercial website with a novel approach to eczema and allergies that helps families ameliorate or eliminate their children’s eczema and other atopic manifestations like asthma without any treatment, by getting to the environmental cause.  Yes, I realize bats don’t get eczema, but please bear with me.  The site has been used by people all over the world, including doctors for their own families, and has inspired a green cleaning book.  Last year alone, even though I don’t do any advertising or optimization, the site had nearly 40,000 unique visitors and 130,000 page views/360,000 hits, plus many thousands more on the associated blog.  Around 80% of the visits are from bookmarks and direct links, only 20% from search engine links, meaning most visits are from people referring the information to each other and returning themselves.

from Sammysskin.blogspot.com

Eczema from detergents,
plus infection Credit: sammysskin.blogspot.com

If you want to see a well-written, well-documented anecdotal demonstration of this, a mom in Georgia has been blogging about using my website to help her once severely eczematous son lead a normal life without treatment (that’s him on the right before she found my website):  http://www.sammysskin.blogspot.com  Again, this does relate to bats, please bear with me.

Eczema, asthma, and allergy rates have risen precipitously in many nations around the world since WWII, affecting nearly every other child in some hotspots. Dogs and cats, by the way, face a concurrent increase in eczema and other atopic manifestations like allergies.  Most mainstream medical researchers acknowledge that even though there appears to be a genetic susceptibility, given the rapid rise, and how those who move from geographical regions with less eczema to regions with more eczema acquire eczema at the higher rates, the cause must be primarily environmental.

Normal skin, no treatment

Sammy’s skin returns to normal
Credit: Sammysskin.blogspot.com
Used with permission

People are using my website to not only eliminate their eczema, but also their asthma, allergies, and dry skin, in the way the underlying basis predicts.  The underlying problem is the way modern synthetic detergents — which are dramatically more hydrophilic and oleophilic than the surfactants (soaps) used by humans for thousands of years prior — affect the skin barrier, causing excess water loss and thinning of membranes.  The reason detergents cause such dramatic effects is not because, as is traditionally believed, washing products strip the skin of oils.  In my observation, it’s because residues that persist on the skin directly increase the permeability and cause excess water loss as a result, even just those residues that migrate from contact with clothing washed in detergent, or detergent-laden dust.  Ingested detergents on dishes and even in processed foods, and inhaled detergents in dust (which is predominantly skin cells and lint in modern indoor environments, in other words, full of detergents) affect lung and gut membranes as well.  The surprise was that ingested detergents also affect skin membranes.  In my experience, the eczema is expressed proportionally to permeability increases.

Everyone, not just those expressing eczema, appears to be affected and experiences degradation of the skin barrier and other membranes.  Only some people, especially children whose skin is naturally more permeable and absorbs more detergents (and proportionally so), experience the eczema more readily.  Detergents also facilitate antigen penetration of membranes and thus overall antigen load, and can negatively impact sensitive membrane healing times.

It is my belief — and I realize these are all just my ideas but they do happen to lead to real solutions for many, many individuals who could not find those solutions in standard approaches on the subject — that the expression of eczema is, under normal environmental conditions and in the absence of these modern exposures, a “healthy” signal from the immune system to the conscious brain when faced with too much allergen/antigen in the environment, under that immune system’s particular conditions at the time, in the same way that pain serves the nervous system (mostly as a warning to the conscious brain).  The classic interpretation of allergy is that the immune system becomes confused and attacks the body, but my interpretation is that allergens being similar to pathogens to the immune system, require more energy to differentiate between them.  If the immune system can “tell” the conscious brain to offload allergens to better and more accurately face a microbial threat, for example, allergy could confer a survival advantage.  Aeroallergens typically produce respiratory symptoms, contact allergens cause skin symptoms, etc.  There is a roughly linear relationship between eczema rates and atopy by nation, and in societies where there is very little of both, the rates of eczema can be very, very small, i.e., the triggering of that signal is uncommon and could be beneficial.

In other words, I believe the eczema itself is a signal that some people express, under certain genetic and physical conditions.  Eczema isn’t a problem that affects one person and never the next, there is a continuum, where more and more people are affected as the environmental cause increases.  Everyone has the potential to express this signal.  In severe atopic dermatitis, the inputs, feedback, skin barrier, immune response, and expression of the signal are all abnormal and out of control because of modern environmental influences, overwhelmingly, I believe, detergents.  The signal is expressed for some people as certain thresholds are crossed, for more and more people as the exposures increase.  Remove those influences, and people can be completely normal, without treatment of any kind.  In order to accomplish that, typically a whole household must make the changes, and inevitably, everyone in the household experiences surprising benefits — most notably to skin but also allergy — not just the person who had eczema.

Healthy Indiana Bat
Credit: Andy King/USFWS

Please continue to bear with me, this is absolutely relevant to bats.  It’s very important to realize that there can be very substantial physiological effects from very tiny exposures.  And in the presence of small amounts of water — sweat, for example, or other membrane surface dampness or condensation — the effect on permeability is dramatically amplified.

In the course of using the website to eliminate eczema, if properly implemented, it is a universal experience that everyone in a household undergoes a beneficial change in their skin, even if they don’t have eczema or atopy.  Over the course of about two months, the skin becomes completely different:  thicker, more supple, and less dry.  Most people are eventually able to wash with soap and stop using moisturizers.  This happens for anyone, for people who use the site just to eliminate dry skin.

Little brown bat with white nose syndrome

Little brown bat with
white nose syndrome
Credit: USFWS

It’s clear, too, from empirical observation, that many people with eczema are affected by fungal organisms (and sometimes bacterial) while the skin is compromised, and those areas must be treated to kill the fungal organisms before the skin will completely heal.  Research (with no cognizance of this detergent issue) also shows that people with eczema are more susceptible to infections on affected skin than people with skin conditions that also disrupt the skin, like psoriasis.  Research with detergents on sensitive eye membranes show they can substantially increase healing times.

Since fungal cells are more like mammalian cells than they are even like bacterial cells, and those fungal cells can replace mammalian cells, it’s necessary to be extremely careful in treating those “infections” or colonizations because if the fungal cells die off all at once, the result could be an alarming and even more compromising loss of skin, such as sloughing off of large surface areas and bleeding depending on how affected it is.  If antifungal treatment is ramped up very, very slowly over time, though, die-off is minimized and normalization of the skin can be achieved over time without the risks associated with sudden die off.  Fortunately, fungal organisms tend to grow slowly, so this process works better with fungal organisms than you might expect with bacterial.

Gray bat

Gray Bat
Credit: USFWS

Here’s why I believe this is important to bats and specifically to your work:  First of all, the obvious:  bats’ wings are mostly skin.  Bats (and frogs) live at that land-water/wet-dry interface, in other words, where they would constantly be affected by the small amounts of water that amplify the detergent effect on membranes I described above.  Although bats to my understanding stay in dry parts of caves, they do live in cool, dark, damp places where fungal organisms can be very opportunistic if a modern influence were to so fundamentally compromise bats’ evolved defenses.  In other words, bats and frogs would in theory be most affected by detergent pollution, the proverbial “canaries in the coalmine”.  It’s interesting that in Australia, Roundup was banned until the maker removed, not the poison, but the detergent in it which was killing frogs.

Foam from aquatic pollutants.
Credit: Eurico Zimbres

Detergents are ubiquitous outdoor environmental pollutants now, especially in aquatic environments.  Their use has been on the rise outdoors as well as indoors in recent decades.  They are readily absorbed (attached to, really) by living membranes.  Bats in particular would be susceptible to exposure, as bats eat a lot of insects, obviously, and presently virtually all pesticides and herbicides for large-scale use are mixed and sprayed with detergents in order to reduce surface tension and spread the active ingredients more evenly.  New biological controls intended to reduce poison use and highly target certain bad bugs without harming the good ones, if sprayed with detergents (as is almost certainly the case), may be having the unintended consequence of exposing bats to more ingested detergents as they consume non-targeted insects that have detergents on them.  Bats could also outright come into contact with sprays or dusts, or detergents in water, and it doesn’t take much.

If detergents affect bat membranes the way they do human skin – and I see no reason they wouldn’t – detergents would both degrade bat membranes (thinning the wings) and make them more susceptible to fungal colonization.  Ingesting detergents also appears to cause eczema and membrane degradation in human skin — difficult-to-correlate membrane degradation even in humans who do not express eczema — and can do so in very, very small quantities.  Although other mammals may not express eczema, which as I believe is an evolved signal/adaptation and not the direct effect of detergent contact irritation, the underlying basis for the skin barrier dysfunction would almost certainly extend to other mammals, whether they express eczema or not.  Since humans and presumably other mammals use endogenous surfactants in critical functions of life, including to control skin membrane permeability, it makes sense that exogenous detergents could throw a monkey wrench in this adaptation.  It’s also very possible that there is no adaptation that would allow for a survival advantage to bats by expressing this signal of eczema as there would be for larger mammals.  In other words, there is no reason to believe bats would experience any benefit from eczema as humans and perhaps even their pets would, so any corresponding genes would have died out long ago.  Nevertheless, bats (and frogs) would experience negative impacts to their membranes from significant exposure to exogenous detergent sources.

I want to reiterate that ingested detergents, even in small quantities, can cause surprisingly significant physiological effects.  The amount of detergent that penetrates the skin of a banana or shell of an egg from normal processing practices, if ingested, is enough to cause patches of skin changes in susceptible infants.  These are some of the most minor influences in a home today, in the most susceptible group — I am just pointing out that if other influences are effectively controlled, in the most susceptible (babies), even such minor influences can have visible effects.  How much more detergent are bats undoubtedly consuming and contacting relative to their body weight and skin surface these days?

I have witnessed infants go from clear skin to bubbly, itchy, severe-looking rash in 20 minutes just from contact with the clothing of an adult who was substantially detergent-free except for face wash or moisturizer containing detergents, with no direct skin-to-skin contact.  I have seen this even from an adult, in similar circumstances, simply leaning over a susceptible infant, without any direct contact.  If these children are removed from the exposure and washed immediately with ordinary soap (see my site for how “soap” is defined, very important) to remove detergents, reversal of even a severe rash to normal skin (provided the infant has been living in a substantially detergent-free environment already) can be just as rapid and stunning.

I think in order for researchers to truly figure out whether it’s possible to help the bats they are studying to recover, researchers probably need to remove that environmental influence from their labs and persons completely.  If researchers are not detergent-free, they are producing detergent-laden dust that would affect creatures as tiny as bats, with already compromised membranes, in ways most people could never imagine.  Understanding these influences from the detergent-eczema arena could shed light on how and why bats are being affected, and how to help them in new ways.  It’s not as difficult as it might sound to achieve results, but it’s necessary to really understand and these are my own novel ideas, not yet in the mainstream of eczema research.  But they are helping a great many people worldwide in the way the underlying ideas would suggest.

I want to propose to you that this line of inquiry is worth looking into, because if detergents are indeed an unrecognized factor in worldwide frog and bat population crashes, rescue of bats may be more effective, and the long-term solutions could be straightforward, if not simple.  People making newer biological controls for targeted insecticides may simply need to take care to use only surfactants which are no more hydrophilic than typical alkaline soaps, for example.

In one interview I read recently, you are quoted as saying, “For a long time, a lot of us — myself included — said fungal infections don’t kill mammals, so that can’t be what’s killing the bats.  But it turns out that because of the bat’s unique hibernation cycle and the nature of the fungus, it does kill them.  The big question now is:  Can we prevent extinction?”  You may be surprised to learn of a growing body of research discussing new kinds of fungal susceptibilities, colonizations and diseases in humans, especially children, because of modern influences.  Like you, researchers believed these microorganisms had no role in human disease — until a variety of new influences like chronic use of steroids or antibiotics — and I would personally add, detergents — created new susceptibilities especially in vulnerable populations.  Given what I have learned over the years about detergents and eczema, I think it’s highly likely that detergent pollution plays a central role in susceptibility of bats to fungal diseases.

Over the years, I have occasionally sent letters like this to researchers without response.  It’s very likely my letters just end up in spam folders, as I expect this one is likely to.  So I am posting it on my blog as well, in hopes that one of my readers may have a bat researcher in their lives with whom they can share it.  This letter also happens to explain the underlying concepts again which, if nothing else, also helps my readers.

I am moved by the specter of the extinction of these beneficial creatures; I hope this letter proves useful to you.  Thank you for taking the time to consider my input.  I wish you all the best in your work to save bats from this urgent threat.

Sincerely,
A.J. Lumsdaine

http://www.SolveEczema.org
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